Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (205 page)
Do not confuse:
hydrocortisone
/HYDROcodone
Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary permeability, and lysosomal stabilization
Severe inflammation, adrenal insufficiency, ulcerative colitis, collagen disorders
Unlabeled uses:
Carpal tunnel syndrome, Churg-Strauss syndrome, endophthalmitis, mixed connective-tissue disease, multiple myeloma, polyarteritis nodosa, polychondritis, pulmonary edema, temporal arteritis, Wegener’s granulomatosis
Fungal infection, hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children <2 yr, diabetes mellitus, glaucoma, osteoporosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, metastatic carcinoma, psychosis, idiopathic thrombocytopenia (IM), acute glomerulonephritis, amebiasis, nonasthmatic bronchial disease, AIDS, TB, recent MI (associated with left ventricular rupture)
Calculator
• Adult:
PO
20-240 mg daily;
IM/IV
100-500 mg (succinate)
• Adult:
IM/IV
(succinate) 50 mg/kg repeated after 4 hr, repeat q24hr as needed
• Adult:
PO
20-240 mg (base)/day in 2-4 divided doses;
ENEMA
100 mg nightly for 21 days
• Child:
PO
2-8 mg (base)/kg/day or 60-240 mg (base)/m
2
/day in 3-4 divided doses
Available forms:
Tabs 5, 10, 20 mg; inj 25, 50 mg/ml; enema 100 mg/60 ml;
acetate:
inj 25
, 50 mg/ml, rectal 10% aerosol foam; supp 25, 30 mg;
succinate:
inj 100 mg, 250 mg, 500 mg, 1000 mg/vial
•
Daily dose in
AM
for better results
•
In one dose in
AM
to prevent adrenal suppression; avoid SUBCUT administration, may damage tissue
•
Do not use acetate or susp for IV
•
With food or milk for GI symptoms
•
Tell patient to retain for 1 hr if possible
•
IM inj deep in large muscle mass; rotate sites; avoid deltoid; use 21G needle
•
Succinate:
IV in mix-o-vial or reconstitute ≤250 mg/2 ml bacteriostatic water for inj; mix gently; give direct IV over ≥1 min; may be further diluted in 100, 250, 500, or 1000 ml of D
5
W, D
5
0.9%, NaCl 0.9% given over ordered rate
Y-site compatibilities:
Acyclovir, allopurinol, amifostine, aminophylline, amphotericin B cholesteryl, ampicillin, amrinone, amsacrine, atracurium, atropine, aztreonam, betamethasone, calcium gluconate, cefepime, cefmetazole, cephalothin, cephapirin, chlordiazepoxide, chlorproMAZINE, cisatracurium, cladribine, cyanocobalamin, cytarabine, dexamethasone, digoxin, diphenhydrAMINE, DOPamine, DOXOrubicin liposome, droperidol, edrophonium, enalaprilat, EPINEPHrine, esmolol, estrogens conjugated, ethacrynate, famotidine, fentaNYL, fentaNYL/droperidol, filgrastim, fludarabine, fluorouracil, foscarnet, furosemide, gallium, granisetron, heparin, hydrALAZINE, insulin (regular), isoproterenol, kanamycin, lidocaine, LORazepam, magnesium sulfate, melphalan, menadiol, meperidine, methicillin, methoxamine, methylergonovine, minocycline, morphine, neostigmine, norepinephrine, ondansetron, oxacillin, oxytocin, PACLitaxel, pancuronium, penicillin G potassium, pentazocine, phytonadione, piperacillin/tazobactam, prednisoLONE, procainamide, prochlorperazine, propofol, propranolol, pyridostigmine, remifentanil, scopolamine, sodium bicarbonate, succinylcholine, tacrolimus, teniposide, theophylline, thiotepa, trimethaphan, trimethobenzamide, vecuronium, vinorelbine
CNS:
Depression, flushing, sweating
, headache, mood changes,
pseudotumor cerebri
CV:
Hypertension
,
circulatory collapse, thrombophlebitis, embolism,
tachycardia, edema
EENT:
Fungal infections, increased intraocular pressure, blurred vision
GI:
Diarrhea, nausea
, abdominal distention,
GI hemorrhage,
increased appetite,
pancreatitis
HEMA:
Thrombocytopenia
INTEG:
Acne, poor wound healing, ecchymosis, petechiae
MS:
Fractures, osteoporosis, weakness
Metabolized by liver, excreted in urine (17-OHCS, 17-KS), crosses placenta
PO:
Peak 1-2 hr, duration 1-1½ days
IM/IV:
Onset 20 min, peak 4-8 hr, duration 1-1½ days
RECT:
Onset 3-5 days
Increase:
GI bleeding risk—salicylates, NSAIDs
Increase:
side effects—alcohol, amphotericin B, digoxin, cycloSPORINE, diuretics
Decrease:
hydrocortisone action—bosentan, cholestyramine, colestipol, barbiturates, rifampin, ePHEDrine, phenytoin, theophylline
Decrease:
anticoagulant effects, anticonvulsants, antidiabetics, calcium supplements, toxoids, vaccines
Increase:
cholesterol, sodium, blood glucose, uric acid, calcium, glucose
Decrease:
calcium, potassium, T
4
, T
3
, thyroid
131
I uptake test, urine 17-OHCS, 17-KS
False negative:
skin allergy tests
•
Potassium, blood glucose, urine glucose while patient receiving long-term therapy; hypokalemia and hyperglycemia; potassium depletion: paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness
•
B/P, pulse; notify prescriber of chest pain
•
I&O ratio; be alert for decreasing urinary output, increasing edema; weight daily, notify prescriber of weekly gain >5 lb
•
Adrenal insufficiency (cushingoid symptoms):
nausea, anorexia, SOB, moon face, fatigue, dizziness, weakness, joint pain before and during treatment; plasma cortisol levels during long-term therapy (normal level: 138-635 nmol/L SI units when drawn at 8
AM
)
•
Infection:
increased temp, WBC even after withdrawal of medication; product masks infection
•
Mental status: affect, mood, behavioral changes, aggression
•
GI effects:
nausea, vomitting, anorexia or appetite stimulation, diarrhea, constipation, abdominal pain, hiccups, gastritis, pancreatitis, GI bleeding/perforation with long-term treatment
•
Assistance with ambulation for patient with bone-tissue disease to prevent fractures
•
Therapeutic response: decreased inflammation, GI symptoms
•
That emergency ID as corticosteroid user should be carried
•
To immediately report abdominal pain, black tarry stools because GI bleeding/perforation can occur
•
To notify prescriber if therapeutic response decreases; that dosage adjustment may be needed; about signs of infection
•
Not to discontinue abruptly because adrenal crisis can result; that product should be tapered
•
That supplemental calcium/vit D may be needed if patient receiving long-term therapy
•
That product can mask infection and cause hypoglycemia (diabetic)
•
To avoid OTC products: salicylates, alcohol in cough products, cold preparations unless directed by prescriber
•
About cushingoid symptoms of adrenal insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain, moon face
•
To avoid live-virus vaccines if using steroids long term
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(hye-droe-kor′ti-sone)
Ala-Cort, Ala-Scalp, Anusol HC, Cetacort, Cortizone-5, Cortizone-10, Cortizone-10 Quickshot, Dermolate, Hi-Cor 2.5, HydroSKIN, Hytone, LactiCare-HC, Maximum Strength Cortaid Faststick, Procort, Texacort
Anusol HC, Cortaid, Cortef, Corticaine, ProctoCream-HC, ProctoFoam-HC, Tucks, U-cort
Locoid, Locoid Lipocream
probutate
Pandel
Func. class.:
Corticosteroid, topical
Crosses cell membrane to attach to receptors to decrease inflammation, itching, inhibits multiple inflammatory cytokines
Inflammation/itching in corticosteroid-responsive dermatoses on the skin, rectal area
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children
Calculator
• Adult/child:
TOP
apply to affected area 1 to 4 times per day
• Adult:
Rectal
1 applicator full of foam once or twice a day × 2-3 wk, then every other day as needed; enema every night × 21 days or until improvement; may use every other night × 2-3 mo; suppository bid × 2 wk
Available forms:
Hydrocortisone:
cream 0.5%, 1%, 2.5%; gel 1%, 2%; lotion 0.25%, 0.5%, 1%, 2%, 2.5%; ointment 0.5%, 1%, 2.5%; rectal cream 1%; rectal ointment 1%; spray 1%; roll-on stick 1%; solution 1%, 2.5%;
Hydrocortisone acetate:
cream 0.5%, 1%, 2%, 2.5%; lotion 0.5%; ointment 0.5%, 1%; rectal foam 90 mg/application; suppositories 25 mg, 30 mg;
Hydrocortisone butyrate:
cream 0.1%; ointment 0.1%; solution 0.1%;
Hydrocortisone probutate:
cream 0.1%;
Hydrocortisone valerate:
cream 0.2%, ointment 0.2%
•
May be used with dressings
•
Apply sparingly in a thin film and rub gently
•
Remove wrapper and insert suppository
INTEG:
Burning, folliculitis, pruritus, dermatitis, maceration
MISC:
Hyperglycemia; glycosuria
Unknown
•
Skin reactions: burning, pruritus, folliculitis, dermatitis
•
Decreasing itching, inflammation on the skin, rectal area
•
That product may be used with dressings
•
To apply sparingly in a thin film and rub gently into the affected area
•
To apply sparingly in a thin film and rub gently
•
To remove wrapper and insert suppository
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTHYDROmorphone (Rx)
(hye-droe-mor′fone)
Dilaudid, Dilaudid HP, Exalgo, Hydromorph Contin
Func. class.:
Opiate analgesic
Chem. class.:
Semisynthetic phenanthrene